Hospice Patients Alliance: Consumer Advocates


"It was a 'Beautiful' Death. It was a 'Terrible' Death"




by Ron Panzer
Pres., Hospice Patients Alliance
November 10, 2010



Part A - "It was a 'Beautiful' Death"



I arrived the last day. It was the usual scene: people flying in from all over the country to be there at the end, getting the family clan together with the old patriarch one last time.

He had been a powerful, successful businessman once, big, tall, and muscular from the pictures hanging on the wall. Now, he was a thin, old, fragile parody of himself. "The way of the world," I thought.

George, the son, the one who never married, had taken control of everything: called in the hospice, had the power of attorney for finances as well as health care decision-making, even made funeral arrangements way ahead of time. He seemed to be on top of it all, although in his own personal life, a lot of people would say he was a "loser." He was the one that called everyone saying, "Dad has taken a turn for the worse. You better come now."

He never seemed to stay with any job for long, if he even was working. Most of the time, he wasn't, just mooched off "Dad." Never found "the right" girl, though he had tried and been rejected by many. His path to financial freedom was clear now: he had gotten Dad to redo the Will last month, leaving almost everything to George. Little did Dad know: George would bring in hospice in less than two weeks after that to "finish the job."

Granddaughter, Kim, told me that Dad had been doing fine, even went shopping at the mall last week. She kept crying to herself, "I don't understand. Why is this happening?" She said Dad wasn't terminal, wasn't very sick at all. Yeah, he was forgetful, but at 78 who wouldn't be, now and then? "He never takes anything more than a Tylenol!" "Why is he even getting morphine?" she wailed.

Kim was Dad's "little girl." In his older years, he had finally found time to be with family and especially doted on Kim. Kim adored him. George reassured her: "It's time to let go, Kim" "You don't want him to suffer, do you?" But she just shook her head and begged them to stop. George smiled smugly and walked away.

For a little while, it had gotten kind of wild, Kim told me. Dad had been screaming, "I don't want that!" "I don't need that crap!" "What are you doing?" George just smiled and had told him, "Don't worry Dad, we're going to take care of you."

And George had made sure the nurses calmed Dad down. Whopping big doses of morphine were squirted under his tongue, even though Dad waved them away and tried to stop them. Now it was too late.

Dad was sleeping now. Sleeping all the time, not just at night. There was no diagnosis that I could think of to explain it, except the medications he was on. "Why is hospice even here," I thought.

Other family members were pacing the rooms, speaking in hushed tones. George seemed to be the only one who wasn't upset. Then again, with his gambling problems and other debts, he stood to make out like a bandit once the estate was released to him. He would get the house, the land, the bank accounts and the cars.

When I went back the next day, one of the nurses told the family, "This is it!" "I just was in to give him his pain medication." "It really looks like he's going tonight." Kim screamed back, "He doesn't have any pain! What are you doing?" Other family members pulled her away and told her to calm down, that there was nothing she could do. Some of the family cried quietly. Some looked like they really didn't care. George was upbeat, though.

I looked at Dad and wondered to myself: "he doesn't have many of the signs of active phase of dying at all. His feet and knees aren't cold or blue or purple. His blood pressure isn't even that low. The only thing was: his breathing was getting very slow, even stopping at times, and the morphine alone could do that." But, I wasn't the case manager, who would listen to me?

Dad did die that night. He just stopped breathing, real peaceful-like. I kept wondering, "What did he die from?" He had been fairly healthy for a 78 year old: he could walk, communicate, eat and even tell jokes. He may have been a little forgetful, but it just didn't make sense. George said enthusiastically, "It was such a beautiful death, so peaceful." "A real death with dignity!" Kim cried out even more and yelled at George, "It's terrible! You killed him, you killed him!"

I knew that like many families, they'd probably never speak to each other again. George would get what he wanted. But what about Kim and the others who loved Dad? What about Dad? It clearly wasn't his time to go. It had been really peaceful, and he had "slept like a baby" (except that he died!). But it was a terrible death, an imposed, manipulated death: that was clear. He didn't have to die that way, then, like that. Anybody with a heart and a clear mind would know it was just plain wrong!




Part B - "It was a Terrible Death"


We were all gathered together in those last days: family, close friends, and a couple of us hospice nurses. We did what we could to care for her, but she didn't want any pain medication even though she winced when we had to help reposition her. She didn't want us to suction fluid from her lungs even though it was getting worse and worse. She didn't even want any sedative to relieve the anxiety that often accompanies such extremely compromised breathing. What she did want was to be wide awake through the end, and we honored her wishes, provided basic care as she would allow and were present, ready to help if we could.

She really wasn't old at all, but neither was she young. It seemed, though, she was too young to die like this, but there was no denying it. She had gotten lung cancer from working at that automotive shop, breathing that asbestos dust for so many years.

Her "quality of life" outwardly was about as bad as it could get. Bad, really bad. And her disease was at the end-stage. She had difficulty breathing and more fluid kept building up in her lungs. We gave her medications to reduce the fluid, but it was a losing battle. Some would've called her stubborn, but she knew what she wanted: she was going to face death head-on, on her own terms, and I respected that.

We helped her sit up in bed, propped her arms up on pillows to help her expand her lungs and breathe, but again, it only helped for a while, if at all. We felt helpless because she refused the relief the doctor had ordered, and he knew his stuff. She had her reasons, being a Christian with strong faith. Everyone understood she was going to die soon, really soon.

She didn't know the term we used, "unfinished business," but she knew what some people don't. She knew what was going on inside herself, and she knew what those last moments with her family meant. She knew that those last moments were all she had with them. And, she had hope.

She never relented even as her lungs filled up more and more. As time went on, it became hard to watch. Her breathing got faster and faster, shallower and shallower. Fading fast!

She could see her family around her, but couldn't speak anymore. They clearly loved her and she loved them, but there was no stopping death now. Sitting up as straight as can be, she looked straight ahead, off into the distance, through us all, just like someone looking at the sun rise over the horizon. But we were inside the living room! What was she looking at?

As she took her last breath, she suddenly had the most beautiful, radiant smile on her face! Some would say it was a terrible death, with her lungs filled with fluid, but you had to be there to feel what we felt, to see what we saw. We knew: it was a beautiful death ... one that I can never forget.



Note: These accounts are from actual events, but details relating to the identity of the individual(s) involved have been significantly changed to protect the identity of those involved.

If you wish to understand how people can have such different views of what makes for a "beautiful" death or a "terrible" death, order your copy of the Life Conference DVD set from the 2010 Life Conference in Raleigh, NC and listen to my talk: "Hospice: Prolife or Culture of Death" and Elizabeth Wickham, PhD's talk, "Repackaging Death as Life - The Third Path to Imposed Death." This 4-DVD collection is being sold at the cost of materials, only $20 in order to make it accessible to all. You can read the transcript of Prof. Wickham's talk at the Life Tree website. Elizabeth Wickham, PhD is the Executive Director of Life Tree organization.



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